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Fistulizing Crohn’s Disease

Fistulas still represent one of the most important complications in patients with Crohn’s disease (CD). At least one third of CD patients suffer from fistulas during their disease course and amongst them longstanding remission of complex fistulas occurs only in about one third. So far, fistula patho...

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Autores principales: Scharl, Michael, Rogler, Gerhard, Biedermann, Luc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539341/
https://www.ncbi.nlm.nih.gov/pubmed/28703786
http://dx.doi.org/10.1038/ctg.2017.33
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author Scharl, Michael
Rogler, Gerhard
Biedermann, Luc
author_facet Scharl, Michael
Rogler, Gerhard
Biedermann, Luc
author_sort Scharl, Michael
collection PubMed
description Fistulas still represent one of the most important complications in patients with Crohn’s disease (CD). At least one third of CD patients suffer from fistulas during their disease course and amongst them longstanding remission of complex fistulas occurs only in about one third. So far, fistula pathogenesis is only partially understood. From a histopathological view, a fistula is a tube covered by flat epithelial cells. Current research suggests that the driving force for fistula development is epithelial-to-mesenchymal transition (EMT). Around the fistula, high levels of tumor necrosis factor (TNF), IL-13, and TGFβ can be detected and recent studies indicated an involvement of the intestinal microbiota. Fistula diagnosis requires clinical and surgical assessment, radiologic investigations, e.g., magnet resonance imaging and endoscopy. Routine medical treatment of fistulas includes antibiotics, immunosuppressives, and anti-TNF antibodies. There is no well-established role for calcineurin inhibitors in fistula treatment, corticosteroids appear to be even contra-productive. A promising novel approach might be the application of adipose tissue-derived or bone marrow-derived mesenchymal stem cells that have been studied recently. Due to insufficient efficacy of medical treatment and recurrence of fistulas, surgical interventions are frequently necessary. Further research is needed to better understand fistula pathogenesis aiming to develop novel treatment option for our patients.
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spelling pubmed-55393412017-08-04 Fistulizing Crohn’s Disease Scharl, Michael Rogler, Gerhard Biedermann, Luc Clin Transl Gastroenterol Clinical and Systematic Reviews Fistulas still represent one of the most important complications in patients with Crohn’s disease (CD). At least one third of CD patients suffer from fistulas during their disease course and amongst them longstanding remission of complex fistulas occurs only in about one third. So far, fistula pathogenesis is only partially understood. From a histopathological view, a fistula is a tube covered by flat epithelial cells. Current research suggests that the driving force for fistula development is epithelial-to-mesenchymal transition (EMT). Around the fistula, high levels of tumor necrosis factor (TNF), IL-13, and TGFβ can be detected and recent studies indicated an involvement of the intestinal microbiota. Fistula diagnosis requires clinical and surgical assessment, radiologic investigations, e.g., magnet resonance imaging and endoscopy. Routine medical treatment of fistulas includes antibiotics, immunosuppressives, and anti-TNF antibodies. There is no well-established role for calcineurin inhibitors in fistula treatment, corticosteroids appear to be even contra-productive. A promising novel approach might be the application of adipose tissue-derived or bone marrow-derived mesenchymal stem cells that have been studied recently. Due to insufficient efficacy of medical treatment and recurrence of fistulas, surgical interventions are frequently necessary. Further research is needed to better understand fistula pathogenesis aiming to develop novel treatment option for our patients. Nature Publishing Group 2017-07 2017-07-13 /pmc/articles/PMC5539341/ /pubmed/28703786 http://dx.doi.org/10.1038/ctg.2017.33 Text en Copyright © 2017 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ Clinical and Translational Gastroenterology is an open-access journal published by Nature Publishing Group. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Clinical and Systematic Reviews
Scharl, Michael
Rogler, Gerhard
Biedermann, Luc
Fistulizing Crohn’s Disease
title Fistulizing Crohn’s Disease
title_full Fistulizing Crohn’s Disease
title_fullStr Fistulizing Crohn’s Disease
title_full_unstemmed Fistulizing Crohn’s Disease
title_short Fistulizing Crohn’s Disease
title_sort fistulizing crohn’s disease
topic Clinical and Systematic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539341/
https://www.ncbi.nlm.nih.gov/pubmed/28703786
http://dx.doi.org/10.1038/ctg.2017.33
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